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Chapter 06 Video 1: Bone Marrow Aspiration from the Iliac Crest

December 22, 2016

Contributors: J Tracy Watson, MD

A small incision is made over the iliac crest. The superior table is identified and a 2-mm drill used to broach the hard dorsal cortex. A multiport large-bore aspiration trochar or needle is inserted between the inner and outer iliac tables. A small amount of aspirate is obtained (using the technique of Muschler. The needle is withdrawn and rotated to aspirate a new region of cells; this is repeated multiple times until the needle is withdrawn. A second or third drill hole may be necessary to obtain the required volume of aspirate. The quantity of aspirate harvested depends on the preferred concentration and amount required for each specific indication. This also can vary with the particular device used to produce the concentrate. Repeat aspiration via different trajectories helps obtain the highest possible cell counts without venous blood dilution before processing. This material is transferred to the concentrating device, which removes the red blood cell fractions and plasma. A substantial volume reduction occurs with most devices and achieves typical total nucleated cell concentration factors that are three to six times the baseline concentration in bone marrow aspirate.